EP1022984A1 - Bestimmung der leberfunktion anhand einer plasmaverschwinderate - Google Patents
Bestimmung der leberfunktion anhand einer plasmaverschwinderateInfo
- Publication number
- EP1022984A1 EP1022984A1 EP99942720A EP99942720A EP1022984A1 EP 1022984 A1 EP1022984 A1 EP 1022984A1 EP 99942720 A EP99942720 A EP 99942720A EP 99942720 A EP99942720 A EP 99942720A EP 1022984 A1 EP1022984 A1 EP 1022984A1
- Authority
- EP
- European Patent Office
- Prior art keywords
- dye
- concentration
- pdr
- measurement
- rez
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
- 230000003908 liver function Effects 0.000 title claims abstract description 15
- 238000005259 measurement Methods 0.000 claims abstract description 18
- 230000004087 circulation Effects 0.000 claims abstract description 10
- 230000003287 optical effect Effects 0.000 claims abstract description 8
- 230000017531 blood circulation Effects 0.000 claims abstract description 3
- 230000006870 function Effects 0.000 claims description 21
- 238000000034 method Methods 0.000 claims description 20
- 230000008030 elimination Effects 0.000 claims description 9
- 238000003379 elimination reaction Methods 0.000 claims description 9
- 210000004185 liver Anatomy 0.000 claims description 9
- 238000005315 distribution function Methods 0.000 claims description 8
- 238000002347 injection Methods 0.000 claims description 6
- 239000007924 injection Substances 0.000 claims description 6
- 230000006978 adaptation Effects 0.000 claims description 4
- 230000005540 biological transmission Effects 0.000 claims description 4
- 238000004364 calculation method Methods 0.000 claims description 4
- 210000000624 ear auricle Anatomy 0.000 claims description 4
- 210000001061 forehead Anatomy 0.000 claims description 4
- 210000004877 mucosa Anatomy 0.000 claims description 4
- 230000003134 recirculating effect Effects 0.000 claims description 4
- 230000008034 disappearance Effects 0.000 claims 2
- 239000008280 blood Substances 0.000 abstract description 5
- 210000004369 blood Anatomy 0.000 abstract description 5
- 239000000975 dye Substances 0.000 description 35
- MOFVSTNWEDAEEK-UHFFFAOYSA-M indocyanine green Chemical compound [Na+].[O-]S(=O)(=O)CCCCN1C2=CC=C3C=CC=CC3=C2C(C)(C)C1=CC=CC=CC=CC1=[N+](CCCCS([O-])(=O)=O)C2=CC=C(C=CC=C3)C3=C2C1(C)C MOFVSTNWEDAEEK-UHFFFAOYSA-M 0.000 description 4
- 229960004657 indocyanine green Drugs 0.000 description 4
- 210000004072 lung Anatomy 0.000 description 4
- 238000011156 evaluation Methods 0.000 description 3
- 239000003814 drug Substances 0.000 description 2
- 239000000126 substance Substances 0.000 description 2
- 102000001554 Hemoglobins Human genes 0.000 description 1
- 108010054147 Hemoglobins Proteins 0.000 description 1
- 230000002159 abnormal effect Effects 0.000 description 1
- 238000010521 absorption reaction Methods 0.000 description 1
- 230000015556 catabolic process Effects 0.000 description 1
- 238000006243 chemical reaction Methods 0.000 description 1
- 238000010586 diagram Methods 0.000 description 1
- 238000010790 dilution Methods 0.000 description 1
- 239000012895 dilution Substances 0.000 description 1
- 238000012905 input function Methods 0.000 description 1
- 238000011835 investigation Methods 0.000 description 1
- 239000000049 pigment Substances 0.000 description 1
- 238000004393 prognosis Methods 0.000 description 1
- 230000000541 pulsatile effect Effects 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/026—Measuring blood flow
- A61B5/0275—Measuring blood flow using tracers, e.g. dye dilution
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/0059—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/026—Measuring blood flow
- A61B5/0261—Measuring blood flow using optical means, e.g. infrared light
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/42—Detecting, measuring or recording for evaluating the gastrointestinal, the endocrine or the exocrine systems
- A61B5/4222—Evaluating particular parts, e.g. particular organs
- A61B5/4244—Evaluating particular parts, e.g. particular organs liver
Definitions
- the invention relates to a method for determining liver function using a plasma shrinkage rate according to the preamble of claim 1 and a device for determining liver function using a plasma shrinkage rate according to the preamble of claim 7.
- liver function is an important parameter in intensive care medicine and crucial for the prognosis of seriously ill patients.
- liver function is being routinely assessed in intensive care medicine using various laboratory sizes that characterize the synthetic performance and the elimination performance of the liver.
- the disadvantage of these laboratory sizes is that if the liver function fails, they only change to abnormal values with a considerable latency over time, so that a liver function disorder becomes evident only after days.
- the indocyanine green is usually injected intravenously as a bolus and, following the bolus injection, at least 2, usually several, blood samples are taken at intervals of several minutes over a period of at least 15 minutes.
- the elimination time constant can be calculated from the drop in the dye concentration in the blood samples. This procedure is described in but rarely used in the clinic, because it is still too time-consuming due to the laboratory analyzes.
- the invention has for its object to provide a method and a device with which the liver function can be determined non-invasively and the measurement result is available more quickly.
- a decrease in a dye concentration in the blood is measured, which is caused by the breakdown of the dye by the liver.
- a suitable dye such as. B. indocyanine green
- injection of a suitable dye such as. B. indocyanine green
- the second maximum arises from recirculation, i.e. before the concentration wave decays on a first pass, a second pass already takes place.
- the mean circulation transit time previously given mtt. can be calculated from a circulatory transport function g (t) that describes the transport behavior of the circulatory system.
- the mean cycle transit time mtt circ is then according to the formula
- the circulation transport function g (t) can be calculated from the measured dye concentration with the aid of an iterative, non-linear adaptation method.
- a model function ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇
- g (t) a m g m (t) + a m + ⁇ g m + 1 (t) + ... + a n g n (t)
- c (t) form the concentration-time profile of the indicator dye
- c D0 us (t) the first portion of the dye concentration-time profile directly passing the measurement site
- c rez (t) a recirculating portion of the dye Concentration-time course
- k the elimination fraction of the dye eliminated by the liver.
- optical measurement of the dye concentration resulting in the blood circulation can alternatively be carried out by fiber-optic measurement in a central vessel or non-invasively by means of light transmission or reflection measurement of light irradiated at suitable body locations, in particular on the fingers, earlobes, bridge of the nose, cheek mucosa or forehead.
- 1 is a graphical representation of the concentration-time profile of an indicator dye
- 2 is a semi-logarithmic representation of the concentration-time curve according to FIG. 1
- Fig. 3 is a graphical representation of the circulatory transport function
- Fig. 4 is a block diagram of a device for measuring and determining the plasma shrinkage rate.
- 1 shows a graphical representation of the concentration-time curve of an indicator substance after a bolus injection.
- sensors are arranged to record the dye concentration-time curve, which are connected to an evaluation circuit and a computer.
- An example of a device according to the invention is shown in FIG. 4.
- the use of a reference dye is cheap but not absolutely necessary.
- the red blood pigment (hemoglobin) can be used as a reference dye.
- one light transmitter 10 operates on a wavelength of 800 nanometers and the other light transmitter 12 operates on a wavelength of 900 nanometers.
- the light receivers 14 and 16 can be designed so that they preferentially filter out these wavelengths.
- the absorption behavior of the dyes can be measured both by light transmission or by light reflection measurement. Suitable places on the body are the fingers, the earlobes, the bridge of the nose, the cheek mucosa or the forehead.
- the signals of the light intensities received by the light receivers 14 and 16 are evaluated by the evaluation circuit 18 and fed to a computer 20.
- This computer 20 first preprocesses the pulsatile components of the light intensities I indpuls (t) and I r ⁇ £ puls (t), for example by forming the quotient:
- the relative dye concentration as a function of time can be determined from these preprocessed signals, also by forming the quotient:
- a non-linear adaptation algorithm from c (t) is used to determine a circulatory transport function g (t), which describes the transport behavior of the circulatory system, and a parameter k, which determines a fractional re-entry rate of the Represents dye after each circulation passage.
- the following is based on a model in which a transport route of the injected indicator dye ICG as a bolus injection first leads through the lungs. Behind the lungs, the transport route is divided into a first, fast compartment, a second, slow compartment and an elimination of the dye by the liver. The first and second compartments then lead back to the lungs.
- the concentration of the indicator dye at the exit of the lungs follows the function:
- c (t) form the concentration-time profile of the indicator dye
- k the fractional re-entry rate of the dye after partial elimi- liver liver.
- the factor k is therefore always less than 1.
- the compartments of the circulatory model are used for g (t).
- Preliminary investigations showed that for dye dilution curves, which were measured on patients, one or two compartments have to be used for g (t), depending on the accuracy that is sought. This results in the general model function
- g (t) a m g m (t) + a m + 1 g m + 1 (t) + ... + a n g n (t)
- g (t) a g ⁇ t) + a2g2 ( fc ) -
- Distribution functions can be optimized according to the method of the smallest quadratic deviation.
- a transport function results as it was calculated as an example for the data contained in FIG. 1 for two compartments and is shown in FIG. 3.
- the resulting transport function g (t) is composed of the transport function gl (t) for the first compartment and g2 (t) for the second compartment.
- the mean cycle transit time (mtt.), which is the first moment of g (t), is also calculated from the transport function g (t): mt
- the plasma shrinkage rate (PDR) of the ICG dye then results as:
- the time constant K ⁇ 1xm of the elimination phase is determined in the linear part of the curve.
- the PDR is:
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Physics & Mathematics (AREA)
- Veterinary Medicine (AREA)
- Biophysics (AREA)
- Pathology (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Public Health (AREA)
- General Health & Medical Sciences (AREA)
- Molecular Biology (AREA)
- Surgery (AREA)
- Animal Behavior & Ethology (AREA)
- Physiology (AREA)
- Hematology (AREA)
- Cardiology (AREA)
- Gastroenterology & Hepatology (AREA)
- Endocrinology (AREA)
- Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)
Abstract
Description
Claims
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE19829273 | 1998-07-01 | ||
DE19829273 | 1998-07-01 | ||
PCT/DE1999/001899 WO2000001297A1 (de) | 1998-07-01 | 1999-07-01 | Bestimmung der leberfunktion anhand einer plasmaverschwinderate |
Publications (2)
Publication Number | Publication Date |
---|---|
EP1022984A1 true EP1022984A1 (de) | 2000-08-02 |
EP1022984B1 EP1022984B1 (de) | 2004-04-14 |
Family
ID=7872560
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
EP99942720A Expired - Lifetime EP1022984B1 (de) | 1998-07-01 | 1999-07-01 | Bestimmung der leberfunktion anhand einer plasmaverschwinderate |
Country Status (5)
Country | Link |
---|---|
US (1) | US6640129B1 (de) |
EP (1) | EP1022984B1 (de) |
DE (1) | DE59909175D1 (de) |
ES (1) | ES2220105T3 (de) |
WO (1) | WO2000001297A1 (de) |
Families Citing this family (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
DE10143995A1 (de) | 2001-09-07 | 2003-04-03 | Pulsion Medical Sys Ag | System und Computerprogramm zur Bestimmung von Kreislaufgrößen eines Patienten |
GB0808777D0 (en) | 2008-05-15 | 2008-06-18 | Norgine Bv | Prognostic method |
Family Cites Families (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
JPH0657216B2 (ja) | 1988-09-14 | 1994-08-03 | 住友電気工業株式会社 | 肝機能検査装置 |
JPH02309929A (ja) * | 1989-05-24 | 1990-12-25 | Sumitomo Electric Ind Ltd | 肝機能検査装置 |
EP0403683A1 (de) | 1989-06-23 | 1990-12-27 | Siemens Aktiengesellschaft | Anordnung zur Untersuchung eines flüssigen Messmediums |
DE4130931C2 (de) * | 1991-09-13 | 1994-05-19 | Hoeft Andreas | Verfahren und Vorrichtung zum Ermitteln des zirkulierenden Blutvolumens |
GB9716962D0 (en) * | 1997-08-12 | 1997-10-15 | Univ Birmingham | Liver function test |
-
1999
- 1999-07-01 WO PCT/DE1999/001899 patent/WO2000001297A1/de active IP Right Grant
- 1999-07-01 EP EP99942720A patent/EP1022984B1/de not_active Expired - Lifetime
- 1999-07-01 ES ES99942720T patent/ES2220105T3/es not_active Expired - Lifetime
- 1999-07-01 DE DE59909175T patent/DE59909175D1/de not_active Expired - Lifetime
- 1999-07-01 US US09/486,670 patent/US6640129B1/en not_active Expired - Fee Related
Non-Patent Citations (1)
Title |
---|
See references of WO0001297A1 * |
Also Published As
Publication number | Publication date |
---|---|
DE59909175D1 (de) | 2004-05-19 |
US6640129B1 (en) | 2003-10-28 |
WO2000001297A1 (de) | 2000-01-13 |
ES2220105T3 (es) | 2004-12-01 |
EP1022984B1 (de) | 2004-04-14 |
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